The New Year’s celebrations may be dying down this week as the healthcare industry gets back to work, but the American Medical Association (AMA) wants providers to keep a watchful eye on ten major challenges that they will face during the year ahead. From ICD-10 to meaningful use to improving population health management and chronic disease care, the AMA list highlights some common complaints.

At the top of the list is a familiar refrain: the ongoing burden of regulatory initiatives such as meaningful use that have frustrated physicians for years. The AMA has long advocated for changes to the program, and plans to “intensify” its efforts to push CMS towards greater flexibility for the program, especially after more than 50% of providers were notified that they will be receiving Medicare payment adjustments in 2015.

The overly-strict requirements of the EHR Incentive Programs “are hindering participation in the program, forcing physicians to purchase expensive electronic health records with poor usability that disrupts workflow, creates significant frustrations and interferes with patient care, and imposes an administrative burden,” AMA President Elect Steven J. Stack, MD said in a statement.

Coupled with meaningful use is the AMA’s other nemesis – ICD-10. While the organization has tried everything from a Twitter rally to Congressional letters to industry appeals in order to continue delaying the code set indefinitely, the new list of challenges takes a bit of a different tack. Instead of reiterating the AMA’s opposition to the codes, the list simply says that the AMA “has advocated for end-to-end testing, which will take place between January and March and should provide insight on potential disruptions from ICD-10 implementation, currently scheduled for Oct. 1.”

“Given the potential that policymakers may not approve further delays, ICD-10 resources can help physician practices ensure they are prepared for implementation of the new code set,” the section continues, which is some of the mildest language the AMA has used about the ICD-10 transition for some time.

Is there a little hint of resignation to defeat now that Congress itself has backed the 2015 implementation date, or will the AMA continue its lengthy fight until the very end? The degree to which the AMA pushes resistance instead of readiness over the next few months may impact how many providers are prepared for the deadline and how many continue to pin their hopes on a postponement.

Other items on the list that will impact physicians in 2015 include the rampant abuse of prescription medications, the spread of diabetes and heart disease, and the need to adequately modernize medical education and the AMA’s Code of Medical Ethics.

The list also highlights the need to continue medical research and the sharing of clinical knowledge, to which end the AMA is launching JAMA Oncology, a new journal in its network of publications. Physician satisfaction and the financial sustainability of medical practices is also on the AMA’s mind as it beta tests professional tools to help physicians chart a profitable course for the future.

To round out the top ten issues for the healthcare industry in the coming year, the AMA includes the need for reform to the Medicare physician payment system after the latest temporary Congressional SGR fix in April, the need to ensure adequate provider networks for patient care, and upcoming judicial rulings on healthcare-related issues such as liability, patient privacy, and the regulation of practices by state licensure boards.

The main goals when it comes to the healthcare industry today, the care of the patient in the most efficient manner possible. Time is also a factor in both the care and efficiency.

The purpose of EHR – Electronic health records is to get the needed information quickly and make sure the patient is on the right path for his or her medical care. The other big concern is the safety of these records.

The traditional EHR has its challenges

In an article on Government Health IT (July 16, 2012), Craig Collins, wrote about the problems involving the management of health records in a traditional data-center. His concerns are listed below.

Forty percent of large patient health data breaches involve lost or stolen devices, according to the U.S. Department of Health and Human Services. The actions of insiders – negligence or willful misconduct by employees and contractors – accounted for nearly three times as many patient record security breaches as external attacks, said a report last year by the Privacy Rights Clearinghouse. Less than 2 percent of healthcare data breaches were from hacking. More than 10 percent were from insider theft or data lost or stolen when being physically transported somewhere else, according to a 2011 survey by the Identity Theft Resource Center. Insider attacks are more costly than outsider attacks, both in dollars and damaged reputation, said a cyber-security survey by CSO magazine last year.

Robert Rowley, MD, also writing for the same site on (July 18, 2012) talks about how the EHR Market is being flooded with vendors.

As a result, large established EHR companies, some of whom have been around for 15 years or more, are experiencing competition from a wave of smaller start-ups – some successful, others not.The beginning of the end – EHR failures

This scenario seems ripe for consolidation. Market forces, however, are rather Darwinian – novel approaches abound (“mutation”), but many will not achieve market penetration (“selection”). Failure of products, even well-designed ones, are part of the start-up experience – true in all market spaces, not just health care.

These companies are reaching out to two distinct categories of EHRs, ambulatory and the hospital. Dr. Rowley goes into detail in his July 15th article, Comprehensive EHR market analysis.

It is important for all medical practices on any level to do as much research as possible to make sure that their investment is a solid, well-chosen one. Attention to Security, by means of a Secure socket layer (SSL) and AES-256 bit encryption should be used. Accessibility, and integration with other networks is critical in our hi-tech world.

According to EHR Scope, in their article, “Is an EHR Usable” (May 25, 2012), there are three main components.

Effectiveness Efficiency User Satisfaction Check out this article we wrote called “When was the last time you gave your practice a Checkup” and learn some ways to make your office more efficient

All of this helps to keep lost time under control. Lost time, lost reports mean lost money and that is not needed in today’s economy. Efficiency, effectiveness, action as well as follow through are the keys to keeping it all under control. Make sure you know how the system functions so you can recognize the benefits you will get through using an electronic health records system.

When it comes to user satisfaction, does it fit your needs? Are you able to personalize settings in the system menus, in the screens and reports? When these are available “their comfort level improves.”

What can develop over time is a smoothly functioning network of physicians, specialists and outpatient testing. As everyone becomes more familiar with how efficient the system functions, it will build up a solid rapport among them. There will be more satisfied patients as well.Concerns about the current system?

What are your main concerns? Do you have any questions to ask as you seek to move forward and upgrade your practice to electronic health records?

While this week marks the end of one and beginning of another year, those in the healthcare industry should take note of all that transpired in the previous year to avoid similar setbacks in 2015. This is especially true for matters scheduled to have been addressed over the last 12 months.

ICD-10 delays, meaningful use changes, health IT vendor competition, and EHR implementation gaffes. Based on the interest of our readers, those were the most popular topics of 2014 on EHRIntelligence.com.

ICD-10 transition delay one more year

More than any other topic on our news site, ICD-10 garners the greatest amount of our readership’s attention and given its high stakes, it makes sense. This past October was supposed to usher in a new era of clinical coding — the move from ICD-9 to ICD-10 — and put the United States on par with other leading nations in terms of healthcare documentation.

What the delay meant to providers depended on where they practices. Larger healthcare organizations reported high levels of ICD-10 readiness while some smaller physician groups and practices were completely unsure where they stood. No matter their view of the most recent ICD-10 delay, most are committed to removing ICD-10 implementation pain points to be ICD-10 ready by Oct. 1, 2015.

Early hints of changes to meaningful use reporting in 2014 emerged as early as February when the Centers for Medicare & Medicaid Services (CMS) introduce a new meaningful use hardship exception dealing with a lack of available CEHRT.

In September, the federal agency finalized a rule intended to give providers greater flexibility in meeting meaningful use requirements in 2014 — known as the flexibility rule. However, this did not turn out to be CMS’s final move.

The flexibility rule was followed by the reopening of the meaningful use hardship exception application submission period for both EPs and EHs and the extension of the 2014 meaningful use attestation period for EHs and critical access hospitals through the end of the year.

Despite their intentions, neither has put to rest repeated calls for 2015 meaningful use reporting requirement changes by industry stakeholders.

Heading to a showdown

Prognosticators in health information technology (IT) have foreseen consolidation in the marketplace over the next few years. But it is unlikely that they saw things playing out as they did in 2014.

While the growth of both Cerner and Epic continues to loom large over the industry, they still have to contend with numerous other players in the ambulatory care space, especially given Epic’s recent loss to athenahealth as the top overall software vendor over the past year.

Expect more to come.

Squeaky wheel gets the grease

When EHR implementations go well, those involved in the process are more than willing to share details of their experiences. When they don’t, it is like pulling teeth.

If 2014 was a busy year, then 2015 is only likely to be busier. Stay with us as we continue our coverage of meaningful use, EHR and ICD-10 implementation, and anything else health IT-related that comes our way.

Different healthcare specialties have different electronic health record (EHR) requirements as there is significant variation in care processes, clinical content and decision support across care settings. For example, a primary care facility’s EHR “must-haves” are dramatically different from those of outpatient surgery center. While the primary care provider sees many patients for a variety of reasons, the surgery center delivers more focused, predictable and short-term care with unique workflow requirements. In the same vein, an ophthalmology practice requires technology to capture data from a number of instruments—often more than many other specialties. Likewise, a dermatology provider often completes numerous procedures in one visit, and an inpatient behavioral health setting with group counseling demands yet another approach to capturing and collecting patient care information.

Despite their diverse EHR needs, there is a commonality among these and other medical specialties: each requires a robust EHR that enables providers to easily gather data, completely and accurately document care, smoothly share information and facilitate good communication to achieve the best patient outcomes. To select the right EHR, specialty practices must fully appreciate how the technology addresses their particular needs and requirements.

Five considerations for selecting a specialty-focused EHR

Verifying that an EHR has the features clinicians need to provide care and manage patients is critical to its success. The following five considerations can guide a practice when evaluating an EHR to ensure the technology meets the organization’s clinical and business specifications, strengthening care delivery while safeguarding the practice’s future.

1. The right content. The first step—and probably the most important—is to look at the depth and breadth of content the solution provides and make sure it fully aligns with the specialty’s requirements. This becomes more complex for a subspecialty. For example, an EHR with strong cardiology features may not meet the distinct needs of a pediatric cardiologist. In these cases, it is also important to select an EHR that can be supplemented with additional subspecialty information to better meet their needs.

2. Configuration flexibility. When specialty practices can easily configure their EHR to reflect workflow nuances, they can optimize data capture, streamline care and improve outcomes. The EHR should allow physicians to easily configure their own templates, yet provide consistency to maintain a high standard of care. For instance, an OBGYN facility needs EHR flexibility for visits ranging from prenatal care and reproductive endocrinology to annual wellness exams. Physicians should be able to customize these forms to match workflow, yet maintain alignment with ACOG (American Congress of Obstetricians and Gynecologists) standards.

3. Smooth integration with current technology. Specialty practices often have more diagnostic equipment feeding data into the EHR than primary care practices. For example, an ophthalmology group may have as many as 12 different devices capturing and sending data to the EHR. Because of this, a practice should closely review how well a potential solution interfaces with the practice’s current technology, particularly focusing on how the EHR incorporates the disparate data into workflow. Specialties linked to a hospital or health system should also assess how seamlessly the proposed EHR share key information with the larger organization. Ideally this is bi-directional!

4. Facilitates the patient experience. Patients can be nervous when they see a specialist, and this can be exacerbated if the physician is more focused on navigating technology rather than talking with the patient. By choosing software that enables patients, medical assistants, nurses and others to capture as much data as possible in the EHR before the doctor enters the room, a practice can allow the physician to focus on the patient’s particular care needs instead of looking at a computer screen to input routine data. Remember, a good EHR gives physicians the right information at the right time to come to the right conclusion while they are in front of the patient. In other words, it keeps the patient at the center of the experience.

5. Strong, Forward-thinking vendor. Not all vendors are equal, and spending time comparing the various options is a valuable exercise. As part of the vetting process, practices should gauge a vendor’s commitment to their specific clinical specialty and learn about plans for future technology development. In addition, consider the vendor’s organizational and financial strength to sustain the cost of supporting the specialty into the future and keeping up with regulatory compliance.

Although specialty practices have historically avoided jumping feet first into EHR technology, this is no longer an option for organizations that want to sustain and build referral volumes. In fact, by selecting and implementing a tool that consistently captures and shares specialty-focused data, providers can position themselves as the expert of choice for both peers and patients.

Physicians are still not sold on the idea of changing their daily workflows to meet the requirements of meaningful use, finds a new study in BMC Medical Informatics and Decision Making. In a survey of 400 providers at 47 ambulatory practices, the researchers found a general unwillingness among all types of physicians to adapt to the needs of Stage 1 meaningful use (MU), and a general lack of confidence in their organization’s ability to rise to the challenges presented by EHR implementation.

The study cites the importance of effective change management strategies as a foundation for preparing healthcare providers for the impact of EHR implementation and meaningful use attestation. “In busy practice settings, such change efforts are often difficult to implement effectively. In fact, experts have suggested that without sufficient readiness for change, change efforts are more likely to lead to unrealized benefits or fail altogether,” the authors write. “With billions of dollars invested in MU and the countless hours spent by providers and clinical staff on MU implementation nationally, unrealized benefits from the program would carry significant financial and opportunity costs for health care systems.”

Resistance to the changes involved in meaningful use is nothing new in the healthcare industry. The study adds to the anecdotal notion that physicians are particularly unwilling to embrace workflow changes due to new technologies and requirements. While approximately 83% of nurses and advanced practice providers (APPs) indicated a willingness to change their workflow in response to meaningful use, just 57.9% of physicians reported the same. Nearly 45% of nurses and APPs believed their organization would be able to address any problems that arose during meaningful use attestation, but only 28.4% of physicians were optimistic about overcoming issues.

Specialists were nearly three times more likely than primary care providers to believe that meaningful use would divert significant attention away from the practice of patient care. Twelve percent of specialists thought their interactions will patients would suffer, compared to 4.4% of other providers. However, specialists were no more likely than other providers to believe their organizations were unready to tackle meaningful use.

“These results suggest that leaders of health care organizations should pay attention to the perceptions that providers and clinical staff have about MU appropriateness and management support for MU,” the study concludes. “Change management efforts could focus on improving these perceptions if need be as it is feasible that doing so could improve willingness to change practices for MU.”

The authors suggest that organizational leaders invest in education for their staff about the benefits and opportunities involved in meaningful use. Creating opportunities to provide guidance, demonstrations, and training for EHR proficiency and documentation measures required for attestation may help to ease trepidation among providers, while indicating a strong sense of support along with a clear implementation framework may help to make meaningful use attestation a more successful prospect.

A centralized EHR infrastructure is promoting care quality improvements in the US Immigration and Customs Enforcement department.

The US Immigration and Customs Enforcement (ICE) system is celebrating the completion its EHR infrastructure implementation, which transformed the agency’s paper-based healthcare system into a centralized, web-based system that allows health information exchange to improve care coordination while cutting costs. For its quick and successful implementation, the team charged with developing the EHR infrastructure has received a 2014 Director’s Award for meritorious service for outstanding performance and inspiring accomplishments advancing the mission of ICE.

As with other governmental healthcare systems, the ICE Health Service Corps (IHSC) must track and coordinate care for persons that may travel between facilities or have a history of care at private providers. IHSC, which operates under the Department of Homeland Security, provides care to around 15,000 ICE detainees at more than 20 facilities, the department’s website says. Patients in the system also receive care from external providers when necessary, which requires the 900-strong IHSC staff to exchange health data electronically in order to ensure continuity.

“The very nature of detainee health care requires sending medical information across different locations,” said Capt. Deanna Gephart, deputy assistant director of Operations for IHSC in a press release. “Now that we have the capability to share data electronically, the detainee health care system is much more efficient, which translates into increased quality health care provided to detainees.”

“I couldn’t be more proud of the effort of the team who dedicated their time and effort to modernizing this system,” added Jon Krohmer, assistant director of IHSC. “In less than 15 months, they successfully acquired, installed, configured, trained and deployed the system to all 22 IHSC-staffed facilities. In the process, ICE has realized a $2 million annual cost avoidance.”

The EHR will allow ICE to better complete public records requests, including the release of data under the Freedom of Information Act, Congressional inquiries, and routine audits. ICE also believes the new system will contribute to a reduction in the risk of medical errors, improved standardization of care, and the ability to better measure and achieve high performance on quality metrics.

Gephart previously noted that the department’s health information management system lacked sufficient interoperability “ICE has a frequent need to send medical information across different locations, which is cumbersome when each site has its own system,” she said in September. In 2012, ICE completed 220,000 intake screenings and 104,000 physical exams while conducting more than 13,000 emergency room or off-site referrals, highlighting the need for robust care coordination throughout the busy system.

The successful EHR implementation comes amidst massive modernization efforts by the Department of Veterans Affairs and Department of Defense (DOD), both of which operate on an even larger scale. Interoperability and care coordination cross multiple facilities are equally critical to these projects, and are some of the major criteria for the vendor selection process as the DOD seeks to leave its legacy systems behind in favor of a newly centralized infrastructure.

Often so deeply immersed in looking for ways to make their practice more efficient, physicians sometimes fail to see the most obvious hurdle preventing this very process from occurring; their EHR. If your Electronic Health Record (EHR) solution is not up to the mark, you might be losing out on precious profits, and incurring costs that you can easily overcome.

The latest results from CMS ICD-10 acknowledgement show no flaws in Medicare FFS claims systems although acceptance rates are lower than March’s ICD-10 testing numbers.

The most recent run of ICD-10 acknowledgement testing by the Centers for Medicare & Medicaid Services (CMS) revealed no problems with the Medicare Fee-for-service (FFS) claims systems but did show a lower rate nationally of accepted test claims as compared to previous testing in March.

“Acceptance rates improved throughout the week with Friday’s acceptance rate for test claims at 87 percent,” the federal agency said in Medicare Learning Network (MLN) Connects update on Monday. “Nationally, CMS accepted 76 percent of total test claims. Testing did not identify any issues with the Medicare FFS claims systems.”

The ICD-10 acknowledgement testing week running the week of November 17 included more than 500 providers, suppliers, billing companies, and clearinghouses and close to 13,700 claims.

“To ensure a smooth transition to ICD-10, CMS verified all test claims had a valid diagnosis code that matched the date of service, a National Provider Identifier (NPI) that was valid for the submitter ID used for testing, and an ICD-10 companion qualifier code to allow for processing of claims,” CMS stated. “In many cases, testers intentionally included errors in their claims to make sure that the claim would be rejected, a process often referred to as ‘negative testing.’”

According to CMS, most rejected professional claims were the result of an invalid NPI while others contained future dates which the acknowledgement testing does not accept.” Additionally, claims using ICD-10 must have an ICD-10 companion qualifier code. Claims that did not meet these requirements were rejected,” the federal agency added.

These most recent results are from the first of a three-part ICD-10 acknowledgement testing series. The next two week-long sessions take place the weeks of March 2 and June 1.

Earlier this year, CMS celebrated the results of a March 2014 ICD-10 acknowledgement testing week, which saw the average of accept test claims nationally reach 89 percent with some parts of the country reporting acceptance rates to close to 99 percent. Acceptance rates for Medicare FFS claims averaged between 95 and 98 percent. Similarly, testing did not reveal any problems with the Medicare FFS claims systems. The March ICD-10 acknowledgement testing week involved an estimated 2,600 participating providers, suppliers, billing companies and clearinghouses and more than 127,000 test claims.

Unlike ICD-10 acknowledgement testing from earlier this year, CMS has provided fewer details about last month’s testing week such as how the acceptance rates of FFS Medicare claims compared to total acceptance rates or other regional comparisons. And beyond highlighting the use of negative testing practices, the federal agency does not include specifics about purposefully erroneous claims and their effects on acceptance rates overall.

The next scheduled ICD-10 testing activities led by CMS take place in January and focus on ICD-10 end-to-end testing.

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